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The Centers for Medicare and Medicaid Services has issued guidance on changes in the Stage 1 electronic health records meaningful use program, some of them which are optional, that went into effect in fiscal year and calendar year 2013:

Computerized Physician Order Entry (CPOE)

Change: Addition of an alternative measure based on the total number of medication orders created during the EHR reporting period

Timing: 2013 and onward

Change: Revised the description of who can enter orders into the EHR and have it count as CPOE

Timing: 2013 and onward (regardless of what stage of meaningful use the provider is attesting to)

Electronic Prescribing

Change: Additional exclusion to the objective for electronic prescribing for providers who are not within a 10 mile radius of a pharmacy that accepts electronic prescriptions

Timing: 2013 and onward

Record and Chart Changes in Vital Signs

Change: Age limit increased for recording blood pressure in patients from ages 2 to ages 3;  no age limit for height and weight

Timing: Optional in 2013; required starting in 2014

Change: Exclusion if the EP sees no patients 3 years or older, if all three vital signs are not relevant to their scope of practice, if height and weight are not relevant to their scope of practice, or if blood pressure is not relevant to their scope of practice

Timing: Optional in 2013; required starting in 2014

Public Health Reporting Objectives

Change: Require that providers perform at least one test of their certified EHR technology's capability to send data to public health agencies, except where prohibited

Timing: Required in 2013 and onward (for all Stage 1 public health objectives)

Electronic Exchange of Key Clinical Information

Change: Objective for electronic exchange of key clinical information no longer required for Stage 1 for EPs, eligible hospitals, and CAHs

Timing: No longer required in 2013 and onward

More information is available here.